Frequently Asked Questions

Teeth & Fillings

Yes, you can. A tooth that is filled is actually weaker than a tooth that has not been filled because the seam between a filling and a tooth is not as good as a solid undecayed tooth. In addition, the unfilled tooth area can also decay, just as it did before.

Pain is a good indicator that there is a problem, but it is also a late indicator. All dental problems start small and don’t hurt. That is the time to fix them, before they hurt. When a tooth hurts, it may already be abscessed and require a root canal. Don’t wait for pain.﻿

Sensitivity to cold means that the nerve of the tooth is inflamed. If the sensitivity goes right away after the cold food or beverage is swallowed, the inflammation is usually reversible by fixing the cause, such as a deep cavity, grinding your teeth or gum recession. If the cold sensitivity lingers, the tooth may need a root canal.

Biting down on hard foods means that there is inflammation at the top of the root, just like walking with a stone in your shoe would cause your foot to hurt. If it is due to biting too hard on the tooth, such as would be the case with a new filling that is too high, or tooth clenching or grinding, fixing the bite will help. If it is due to an infection in the tooth, a root canal is probably needed.

Chips in teeth are caused by mechanical trauma such as a blow to the tooth or, more commonly, tooth grinding. You can see if the chipping is due to tooth grinding by putting your top and bottom teeth together edge to edge, and seeing if the chips or worn spots on the top and bottom teeth line up.

Usually these sensitive areas are caused by tooth clenching or grinding. The solution is to try to desensitize them by using a prescription-strength fluoride product, such as Prevident, if over the counter products like Sensodyne don’t help. Also, you need to determine the cause, such as tooth clenching or grinding or gum recession, and correct that to prevent the problem from getting worse.

﻿You don’t have to keep getting cavities. You have to stop what is causing them. Cavities are due to either eating too much sugar relative to the strength of your teeth and not flossing, or due to old fillings leaking and letting decay under them. You need to discover the problem and then cut down your sugar, start flossing and fix leaking old fillings. Using a prescription strength fluoride is helpful too.

Today, you do not need to have old fashioned metal fillings in your mouth. Bonded fillings, inlays and crowns are all natural tooth color and can be used to replace old fillings to give you a younger, natural look.

A tooth with a cap is much less likely to decay than one with a big silver filling that is more prone to cracking and leaking. However, a cap is not a permanent solution to prevent decay. You still have to brush and floss and avoid sugar foods because where the cap ends the tooth can still decay.

Except for wisdom teeth, teeth that are lost should generally be replaced because when a tooth is lost, several things happen. The other teeth may start to shift, causing food traps which can lead to more decay or gum disease. In addition, it can throw the bite off leading to bite problems. The last problem is difficulty with chewing, leading to poor digestion and eating processed foods which aren’t as healthy as harder to chew fresh fruits and vegetable and high fiber breads and cereals.

Food traps between your teeth may be due to cavities between the teeth, fillings that are breaking or your teeth may be shifting if you have lost and not replaced missing teeth. It is important to fix these problems because the trapped food can cause gum disease in addition to being annoying.

If you have fillings that do not match the color of your teeth, you can have them replaced with new bonded fillings. Over time, tooth-colored fillings, especially the older ones, can discolor, or the color of your teeth may have darkened due to food or beverage stains. Modern bonded fillings hold their color for much longer than older materials.

No one likes the numb feeling, but most people prefer numbness to pain. If the cavity is small, you may be able to do it without Novocain. Also, air abrasion, which does not use a drill, can sometimes be used for smaller cavities without Novocain.

The heart pounding is an annoying but temporary effect of a chemical in the local anesthetic that helps it work better. If it is a problem for you, there are local anesthetics that do not have that chemical. Often those don’t last as long, so for a longer procedure, the numbness might not last long enough, requiring re-injection of additional local anesthesia. Ask Dr. Phelps what would be best for you.

Generalized sensitivity of teeth is usually due to gum recession caused by gum disease or tooth grinding due to a bite problem. You need to find the source of the problem and fix it. If it is only one tooth, then it could also be due to decay.

The safety of mercury fillings is very controversial. The American Dental Association and many other organizations says it is. Many other people are concerned that it may not be safe. Several European countries do not permit its use in children. The instructions supplied by manufacture of silver mercury fillings in the USA say not to use it in patients with kidney disease or compromised immune systems. The Environmental Protection Agency says that when dentists do a silver mercury filling in a patients tooth, any unused filling material must be stored in a covered container and disposed of as medical waste. Dentists are not allowed to store scrap filling material in an open container. This leads us to believe that there may be a problem, so we do not use silver mercury fillings at all. For additional information, visit http://www.iaomt.org.

We do not use silver mercury fillings for several reasons. First, they tend to corrode and leak, permitting further decay. Second, they have a tendency to expand over time like ice cubes and can cause otherwise healthy teeth to fracture. Third, they are unattractive and tend to darken teeth. Fourth, although the ADA says that they are acceptable for continued use, there is some concern about the safety of mercury and some people are intolerant to mercury in fillings.

Silver mercury fillings can be removed easily and replaced with tooth colored materials. The dentist does it all the time if there is decay or if they are leaking or broken. They can be removed for cosmetic reasons to lighten dark teeth as well, as if the patient requests it.

Gold is a very excellent material but some people object to its appearance, even in back teeth. Now there are several choices of materials to repair decayed or broken teeth. Laser bonded composite fillings are used for small-to-medium-sized cavities. They are natural tooth color. Gold or porcelain inlays are used for very large cavities. The traditional gold, while an excellent material in terms of durability and strength, is generally not selected in areas where it would be visible. Porcelain, on the other hand is very natural looking. In the case of even more extreme tooth damage, a porcelain crown can be used.

There are three reasons why a restoration in a tooth could fail. First, the material could break or wear out. Second, the remaining tooth could break or start to decay. And third, some conditions such as gum disease could damage the support of a tooth or cause gum recession that would cause a cosmetic problem with an otherwise successful restoration. Based on this, considering that people bite, chew and swallow 24 hours a day, eat cold foods and drinks as low as 35 to 40 degrees (F) to hot beverages as warm as 150 degrees (F), there is nothing that could be considered “permanent”. That said, if the material selected is appropriate for the size of the cavity and the individual brushes and flosses daily, eats minimal sugar and uses prescription strength fluoride, most dental repairs will be very long-lasting.

To help your kids avoid decay, make sure they are getting optimal fluoride in water or by prescription and minimal sugar. In addition, make sure they are getting dental check-ups twice a year to catch problems while they are small and practice effective plaque removal at home.

Teeth that are filled can get more decay if the filling chips or cracks open and starts to leak. That is why the material selected must be strong enough. In fact, an extensively filled tooth is generally weaker than an unfilled tooth. In addition, if the person does not practice effective plaque control and continues to eat too much sugar for their own system, decay can start in the remaining unfilled tooth structure.

﻿To check for decay, you need to use a combination of dental x-rays to “look” in between the teeth where you cannot see. In addition, it is necessary to use a video enhanced system to magnify the size of the image so small cracks or chips in the filling that allow decay can be found. Very large cavities often form under what appears to be acceptable old fillings. These cavities can easily be missed unless the teeth are carefully evaluated.

﻿X-rays, when used properly, are definitely safe. Over the years, the amount of radiation has been going down as better systems have been developed. Today, the average set of dental x-rays provides far less radiation than a day in the sun. And remember, the dental technician uses a lead apron to cover your neck, chest and stomach to minimize radiation exposure.

You need dental x-rays because there are some areas like in between the teeth or under the gum line that are just not visible any other way. If the doctor does not catch decay, infection or bone tumors while they are small, and waits for the patient to complain of pain or other symptoms, little cavities can grow to the point where root canal is needed.﻿

Most commonly, teeth break due to large cavities weakening the remaining tooth structure. That is why, with large cavities, they usually need to be fixed with a material that can strengthen the tooth, such as a crown. The other reason teeth sometimes break is from the pressure of tooth clenching or grinding, which is far more common than most people think.

If you have decay, an x-ray may not find it depending on where the decay is located on the tooth and whether there is a metal filling in the tooth that could block the x-rays. That is why you need to combine dental x-rays and a careful, video enhanced dental examination.﻿

From a decay point of view, two good brushings a day will clean the places a brush can reach. The problem is that the brush can’t go between the teeth where most decay forms. No amount of brushing will replace flossing. They just don’t do the same spots. Just like cleaning the bathroom 6 times a day doesn’t make the kitchen clean. You need to brush and floss.

Yes, it does. Adults can get great benefits from fluorides applied to their teeth on a daily or weekly basis because fluoride hardens the outside of the tooth. If the outside is harder, decay can’t start.

Yes, you absolutely can get a preview before your work is done. Cosmetic Imaging is a system where we take a picture of your smile and then, in our computer, change your teeth so you can see how great you would look with cosmetic dental treatment.

Cosmetic Dentistry

Yellow teeth can be whitened by bleaching them or by putting porcelain veneers or crowns on them. If the teeth are not extensively decayed or filled and generally good looking, except for the yellow color, bleaching is the easier, most conservative and least expensive option.

In addition to braces, teeth can be straightened by using porcelain veneers or crowns. This method is especially useful with adults who want a result in two weeks, instead of two years. In addition, if the teeth are dark or have decay or unattractive old fillings, that can all be corrected at the same time.﻿

You cannot be too old to whiten your teeth. Some of our most excited tooth-whitening patients have been in their seventies and eighties as they found that tooth whitening quickly and easily takes years off their appearance.

A dentist trained in proper cosmetic dental procedures does not create the “white chiclet” tooth look you may have seen. We can discuss the shape, color and arrangement of your teeth so you get a great “natural” looking smile.

The dark area at the gum line with traditional caps is usually due to metal in the crowns. At our practice, with teeth that show when you smile, we avoid metal in crowns whenever possible and use all ceramic crowns.

Cosmetic dental procedures can be accomplished in as few as two visits over as little as a week or two. Of course, every patient's situation is different so you need to discuss your specific requirements and circumstances with us prior to starting any cosmetic work.

Bleaching is an inexpensive process that is designed to take the dark pigments out of the teeth. It will not whiten fillings or crowns on teeth. In addition, certain types of discolorations tend to respond better to bleaching than others. Based on our experience bleaching several thousand people's teeth, we can give patients a reasonably accurate predication of the results they can expect with tooth bleaching, but there can be no guarantee of results.

The bleaching materials we use today were actually developed originally as a treatment for periodontal disease. Researchers noticed that, while they had no long term benefits for gum disease, the oxygen released during the bleaching process did help kill certain types of bacteria during the actual bleaching sessions.

Porcelain veneers are very strong and the glazed surface is generally impervious to stains. Just like a dinner plate can be washed, porcelain veneers can be cleaned and professionally polished to keep them looking great.

Porcelain veneers last for many years. As long as the patient exercises proper home care to prevent decay or gum problems, gets regular professional cleanings at least twice a year and avoids unreasonable force on their teeth, they can expect many years of service from porcelain veneers. You cannot abuse them by using your veneered teeth to crack open nuts, pull pins out of shirts, or as one of our patients said, “use your teeth like a Swiss Army Knife”. Doing so would likely cause breakage.

You can eat normally with veneers. Foods like corn, apples, chicken, ribs, fresh fruits and vegetables, carrots, etc., are all fine. So are sandwiches and bagels. You cannot use your teeth to break open nuts or eat stale breads that would require a hacksaw without causing veneers to develop cracks or actually break. Repeated abuse of veneered teeth will weaken them and then, one day, something might break while you are eating a tuna fish sandwich on white bread. This would only happen if the veneers had been damaged by prior abuse.

A classical porcelain veneer covers just the outside and biting edge of a tooth and requires a minimal amount of tooth reduction. A crown would go completely around a tooth and require more then twice the amount of tooth reduction. That is why we recommend porcelain veneers unless the tooth is extensively decayed beyond the point where a crown is necessary. Sometimes, in one patient, we use a combination of porcelain veneers and crowns to get the best most conservative result.

You can always start with bleaching and then use veneers later. In your consultation with the doctors, they will let you know what results you can expect from bleaching and then you can decide what you want to do. Some people may decide to start with bleaching and contouring and then do veneers in the future.

It depends on how they are whitened. The same process that lets us bleach teeth can let them darken again. Teeth are permeable. That means stains can go in and out. Generally teeth that have been bleached will darken a little over time but it would take at least several years for them to return to their original color. If the teeth are whitened with veneers or crowns, they will not darken significantly at all.

If they darken more than you want, you can them again. As long as you save your models and bleaching trays, you can do a touch up bleaching for a few days at any time in the future by purchasing an inexpensive touch-up kit of bleach material.

Some people simply start out with darker teeth than other people. Anything that could stain a white cloth can cause your teeth to darken. The worst offenders are smoking of any kind, dark beverages like red wine and cokes, and dark gravies and sauces. Skipping regular cleanings also lets deposits build up and penetrate into the tooth to darken them.

Regardless of your habits, you can have whiter teeth. If your teeth are dark and your habits tend to stain your teeth, you will get a less than desirable result from the tooth bleaching and will have to do it longer and more frequently. You do have other options, such as porcelain veneers, that can give you the color you want without relying on tooth bleaching.

Dental Treatments - Root Canal

A root canal is done to remove the infection and seal the canals in the tooth. This can often be done in one visit. Sometimes two or three visits are needed depending on the individual tooth and degree of infection.

Root canal treatment is done in the case of an infected nerve. Usually a tooth having root canal treatment can be made numb with a local anesthetic and it doesn’t hurt at all. Sometimes, a tooth with an infected nerve does not react to Novocain as well as a normal tooth and takes more work to get it completely not sensitive.

The root canal treatment was fine. The problem is the tooth was weakened by prior decay and required a cap to fix the tooth. If that was not done, the tooth. even with a successful root canal can break.

A root canal is needed due to an infection in the tooth. This is usually due to an extremely deep cavity or, less often, due to a blow to the tooth. A tooth could have a deep cavity and the doctor might not know that the tooth needs a root canal because nothing shows in an x-ray and the patient has no pain. Then, a week or a year or many years later, something may show up in an x-ray or the patient could report pain. If that happens, root canal treatment would be done at that time.

Dental Treatments - Gum Treatment

Gum disease can be controlled and slowed down, but in cannot be permanently cured. Anyone with teeth can develop gum disease. If you have already had problems with your gums, you know you have the potential for future problems. However, you do not need to lose your teeth because of it. If you can control the cause of gum disease your gums can be returned to a state of health and you can consider yourself a “healed periodontal patient”.

Periodontal surgery is done in a case where there is extensive gum disease, bone loss or gum recession. In cases where the gum disease is more moderate, more conservative procedures such as scaling and root planing may be performed.

Bleeding gums is a sign of infection but bleeding gums alone do not tell us how extensive the damage is or what treatment is needed. Unless there is an acute abscess, we always start with cleanings, scaling and root planing and, especially, home care instructions. Sometimes that is all that is needed to treat the gum infection.

Gum recession can usually be prevented by detecting a condition that could cause the recession and then stopping it before recession occurs. Examples of causes of gum recession are gum inflammation that could lead to recession and bone loss, tooth clenching and grinding that can lead to bone loss, developmental defects in the gum tissue or cheek muscles and, rarely, people who brush compulsively with a very hard tooth brush.

Loose teeth are a sign of bone loss. A tooth with healthy bone will never be obviously loose. If the damage is not too severe, especially if it is due to tooth clenching or grinding, the damage can usually be reversed by fixing the bite. If the tooth is moderately loose due to bone loss, it is often possible to join it to a stronger adjacent tooth, often with a cap to strengthen it. If it is very loose due to severe bone loss, it may not be treatable at all.

Dental Treatments - Dental Implants

Placing dental implants is a surgical procedure, so there is definitely some mild discomfort after the surgical phase. After the initial healing phase passes, there is nothing to be fearful of in so far as pain is concerned.﻿

Placing an implant requires one surgical visit and several follow up visits to check the healing and remove the sutures. The purpose of the dental implants is to replace missing teeth, so in addition to the surgical placement of the implants, the patient must wait 3 to 6 months while the bone heals and then another month or two for the final dental bridgework.

You cannot be too old for dental implants. The issue is your health. As long as the patient is a candidate for elective surgery, they can have dental implants. A patient with medical conditions such as uncontrolled diabetes, heart disease, severe hypertension etc., would not be an appropriate candidate for dental implants.

Medical conditions that would preclude the placement of dental implants would include people with problems healing, such as people with AIDS and people who are not candidates for elective surgery, such as people who have uncontrolled diabetes, severe high blood pressure or heart disease.

Dental implants are often used to replace several missing teeth when there aren’t sufficient teeth for fixed or non-removable bridgework. In that case, one implant is generally placed for each missing tooth to be replaced.

Placing dental implants and then putting a cap on it is a great way to replace a missing tooth if you do not want to put caps on the teeth adjacent to the missing tooth, or if there aren’t enough strong teeth to support a fixed bridge near the missing tooth. This is especially true if the adjacent teeth are perfectly healthy, straight, decay free-teeth and the patient would rather avoid capping them.

The disadvantage of the implant is that two surgical procedures need to be done to place the implant and then place the supporting post in the implant so that a cap can be placed to replace the missing tooth. This takes several months. And the cost for a dental implant, plus the post and crown, is greater than a conventional fixed bridge. If the patient has perfectly good teeth adjacent to the missing tooth, the benefits of not having to cap those teeth may be worth the extra time and expense.

If the teeth adjacent to the missing tooth are crooked, decayed or already have big leaking fillings, and need to be capped anyway, it makes no sense to go through the time and expense of a dental implant and then have to cap the adjacent teeth anyway. Also, if there is not an adequate amount of jaw bone to hold the dental implant, bone grafting procedures may need to be done and the patient would need to evaluate the benefits of the implant approach versus the time and expense of the implants and bone graft.

There are times when dental conditions such as bone loss or gum recession may allow a dentist to use a dental implant to adequately replace a missing tooth but not restore the normal shape and contour of the gum tissue. In the back of the mouth, where it doesn’t show, this may not matter. In the front of the mouth, it could result in a chewing success but an appearance failure. That is one reason why dental implants, as great as they are, are not a panacea for the replacement of all missing teeth.

The sensitivity can be treated by fluoride treatment, repairing the gum recession or replacing a bonded filling in the tooth, depending on the situation. Finding the cause ofthe recession is very important so the process can be stopped or it will continue.

If you don’t stop the gum problems, it is likely that you will lose teeth. However, gum disease can be successfully treated and controlled with modern state-of-the-art periodontal care as long as you catch it soon enough. Do not wait till it gets so bad that it is too late.

Hormonal changes affect all of the body, including the reaction of our gums to the germs in plaque. In other words, the plaque causes gum problems. The hormonal changes lower the body's resistance to plaque. Extra flossing and brushing should stop bleeding gums during menstrual cycles and pregnancy.

No, they don’t cause gums to bleed. Germs cause gums to bleed. However, certain medicines, like anti-convulsion drugs such as dilantin and blood pressure drugs such as Norvasc, do make your gums more sensitive to plaque that is already there, resulting in more bleeding.

Pain in the gums is the result of an acute gum infection. Causes could be gum abscess or an abscess originating from a tooth. Virus infections such as herpes can make gums sore. Canker sores, cold sores and trench mouth (ANUG) can also make the gums hurt.

It could be a sign of a gum infection called ANUG. This also used be called Trench Mouth and typically occurs in teenagers and young adults who don’t brush and floss regularly when they are going through a period of high stress.

Yes, it could. Bacteria and bacterial products such as sulfur compounds can accumulate and putrefy. These compounds taste and smell like rotting meat - a most unpleasant taste and smell. Unfortunately, most people cannot smell their own breath and don’t notice the foul taste of gum disease because they get used to it.

Today, the most effective toothpastes and mouth washes to fight periodontal disease are the ones that contain chlorine dioxide. There are several brands, most of which have been developed by a dentist and dispensed directly from dentist offices. They are designed to neutralize and break up the volatile sulfur compounds that are made by bacteria to break down the gum tissue.

They are both the same thing. If plaque builds up on the teeth and is not removed every day, calcium in the saliva may be deposited into the plaque, creating a hard layer on the teeth. If that is not cleaned off by your dentist or hygienist, it encourages more plaque to form and leads to gum disease.

Gum disease rarely hurts. In fact, sometimes the only sign of gum disease is when a patient notices a tooth has become loose or a bad taste develops in their mouth. At that point, it may be too late to save the tooth. Regular cleanings and check-ups are the key to discover these problems before they get too bad.

The frequency of professional cleanings depends on the individual. Everyone is different. Some people need more sleep than others to be properly rested, and cleanings are no different. People with good plaque control, daily brushing and flossing and high natural resistance can have cleanings twice a year and still maintain optimal dental health. People with less effective plaque control at home and lower natural resistance need cleanings three or four times a year.

Hard brushing with a hard toothbrush could cause gum recession over a long period of time but hard brushing is usually not the problem, especially if you use a soft brush. Gum recession is usually due to other factors such as tooth grinding.

Even if there is a filling in the tooth in the receded area, it probably can be fixed. You’ll need to consult with a Periodontist to be sure. The procedure is to remove the old filling or even a crown, graft the gum tissue to fix the recession and, in the case of a crown, make a new one. In the case of a filling, a replacement is usually not needed.